Cancer Center Sterilization

This prominent Los Angeles-area cancer hospital was one of my first exposures to healthcare delivery as a consultant. By the time I got there, my firm had thoroughly indoctrinated me on Lean principles. Of course, I had spent a career in innovating solutions. I now had a portfolio of experience that included both the operations and design worlds. Previously, I had worked at a medical device company, and now I was where the nurses, doctors, and surgeons were doing their job. Ready, set, go!

Our operations consulting delivery model was to place a consultant at a client with a team, in a conference room for an entire week. I shared in the Navy A.D.D. moment that the first three days can be quite difficult, typically because we uncover a significant amount of procedural waste. Despite the fact that employees can feel the pain, some leaders have trouble admitting their existing process needs to change and that they weren’t leading the team in the optimal direction.

The task here seemed simple: redesign the area and the process used to sterilize the surgical equipment. Things did not go smoothly. The amount of push back we received from the new department manager and the “sterilization expert” was so high that they tried to cancel the engagement after just one day. As consultants, this experience isn’t out of the ordinary. We have to have an escalation path. In this case, it was the Chief Nursing Officer. Magically the new manager and team aligned with our method and findings.

As we were digging into the details of what was currently occurring with sterilization, the main problem became readily apparent. Each surgeon had their own set of requirements, based on what procedure they were doing. However, the department providing the surgical instruments wanted to have a standard kit for all surgeons. As you can imagine, we were re-sterilizing many instruments that surgery didn’t use. In fact, about 70,000 a year that were never used were re-sterilized. Each had been exposed to the atmosphere of the surgical suite, thus contaminating them.

We defined the challenge as “putting the correct instrument in the surgeon’s hand when asked for during the procedure.” From there, we were able to come up with a process to do just that. As a result, we drastically reduced the number of instruments in a kit as each surgeon got their own custom kit. It required a bit more coordination on the sterilization department, but it saved the hospital a lot of money. Annually, tens of thousands of instruments avoided the destructive process of repeated sterilization-without-use. There were savings in both the process and purchase budget. That savings could fund treatment for the patient instead of repeat sterilization of an unused instrument.